RESUMEN
Clostridium difficile (CD) is one of the most common causes of diarrhea in solid organ transplantation (SOT). Between 1996 and 2005, a total of 2474 solid organ transplants were performed at our institution, of which 43 patients developed CD-associated diarrhea. There were 3 lung, 3 heart, 20 liver, 8 kidney-pancreas, 6 kidney, 1 composite tissue, and 2 multivisceral recipients. Onset of CD infection ranged from 5 to 2453 days posttransplant. All patients presented with abdominal pain and watery diarrhea. Toxins A and B were detected using rapid immunoassay or enzyme immunoassay. Treatment consisted of reduction of immunosuppression, fluid and electrolyte replacement, metronidazole (n=20), oral vancomycin (n=20), and a combination of metronidazole and vancomycin (n=2). Toxic megacolon was seen in five patients. Two of them had colonoscopic decompression, and the remaining three required colonic resection. One of these patients died due to multiorgan failure after cured CD enteritis. The remaining patients were discharged with well-functioning grafts and all are currently alive. CD colitis was a rare complication prior to 2000; 38 of the 43 cases occurred thereafter. We conclude that CD colitis represents a severe complication following SOT. Recently, a dramatic increase in the incidence of this complication has been observed. The development of life-threatening toxic megacolon must be considered in solid organ recipients.
Asunto(s)
Clostridioides difficile/aislamiento & purificación , Enterocolitis Seudomembranosa/etiología , Trasplante de Corazón/efectos adversos , Trasplante de Pulmón/efectos adversos , Antibacterianos/uso terapéutico , Proteínas Bacterianas/análisis , Toxinas Bacterianas/análisis , Colectomía/métodos , Colonoscopía , Descompresión/métodos , Diagnóstico Diferencial , Enterocolitis Seudomembranosa/diagnóstico , Enterocolitis Seudomembranosa/terapia , Resultado Fatal , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Diatrizoato/uso terapéutico , Ácidos Grasos/uso terapéutico , Trasplante de Páncreas/efectos adversos , Conductos Pancreáticos , Fístula Pancreática/terapia , Glicoles de Propileno/uso terapéutico , Soluciones Esclerosantes/uso terapéutico , Zeína/uso terapéutico , Adulto , Combinación de Medicamentos , Fármacos Gastrointestinales/uso terapéutico , Humanos , Masculino , Octreótido/uso terapéutico , Fístula Pancreática/complicaciones , Pancreatitis/etiología , Tomografía Computarizada por Rayos XRESUMEN
The Organ shortage has caused an accumulation of acutely decompensated patients listed as medical urgency code 2 (MUC 2) (United network for Organ Sharing 2) while awaiting liver transplantation. Between June 1997 and June 2003, 22 of 360 liver transplantation patients (6%) were listed as MUC 2. Prophylactic immunosuppression consisted of calcineurin inhibitor-based drug therapy, using antithymocyte globulin or interleukin-2 receptor antagonist induction in 64%. The overall perioperative infection rate was 50%, and the rejection rate was 23%. We observed 7 episodes of oral or genital herpes simplex virus lesions; 2 patients (both with cytomegalovirus-mismatched transplants) developed cytomegalovirus disease, and another 5 patients received ganciclovir for preemptive therapy or prophylaxis. Two patients developed pneumonia: 5, sepsis that originated in 4 cases from a contaminated central venous line; and 1 methicillin-resistant endocarditis, which resulted in Staphylococcus aureus lethal outcome. After a median follow up of 3 years, 1 patient underwent a repeat transplantation procedure and 6 patients had died, 4 of them from infectious complications. Liver transplantation of MUC 2-listed patients may result in acceptable results similar to those of MUC 3 and MUC 4 categories.